Aftercare Following Surgery
World Small Animal Veterinary Association World Congress Proceedings, 2015
T. How

Dogs with elbow dysplasia (ED) that undergo surgery almost always have some degree of osteoarthritis. Postoperative management following elbow surgery is therefore best tailor made and composed of a combination of medical therapy, nutritional support and physical rehabilitation. The nonsteroidal anti-inflammatory drugs (NSAIDs) are the main drugs used in osteoarthritis and can be given for longer periods of time. Side effects involving the gastrointestinal tract, platelets and kidneys must be monitored in cases of long-term administration. Corticosteroids are very strong anti-inflammatory drugs, but are not used routinely because of the risk of cartilage damage and progressive joint destruction. Platelet-rich plasma, stem cell therapy, hyaluronic acid, polysulfated glucosaminoglycan, chondroitin sulfate and glucosamine sulfate/hydrochloride are used frequently, but evidence is not always sufficient for their recommendation for routine use in dogs. Omega-3 fatty acids have been proven to have anti-inflammatory effects in dogs and are available as a supplement or added in commercial diets. Postoperative bandaging is not indicated after arthroscopy. Soft-padded bandage, however, can be used for 24 to 48 hours after open procedures or after significant extravasation of fluid during arthroscopy. Activity must be restricted in the first 10 to 12 weeks after surgery. The first 3 weeks only very short (5 to 10 minutes) walks on the leash, several times a day. Depending on the progression, walks can be extended accordingly.

Physical therapy can help restoring the limb function without overloading the operated leg. Besides exercise restriction the importance of weight management cannot be overestimated. Keeping the animals weight at the low end of the normal range slows the progression of degenerative joint disease. Client education must also emphasize that surgery and postoperative management in ED are not curative procedures, but are to improve joint function and slow down osteoarthritis.

Many affected dogs, however, will have progressive osteoarthritis despite surgery. Medial compartment syndrome can be a deleterious condition that causes severe lameness and discomfort in ED patients. Lameness due to OA (lame after rising, especially after heavy exercise before the rest period) should be differentiated from lameness which increases during exercises and which warrants a careful examination of biceps tendinitis. In cases in which advanced degenerative joint disease doesn't respond to therapy, corrective techniques as SHO, PAUL, CUE, joint replacement, arthrodesis or salvage procedures are possibilities.

  

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T. How


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